Bilateral Macular Neovascularization Secondary to Sepsis from a Shunt Infection

PURPOSE: To report a case of bilateral macular neovascularization (MNV) secondary to septic embolism from a shunt infection. METHODS: Observational case report. RESULTS: A 57-year-old female on maintenance hemodialysis experienced cardiac arrest due to sepsis and was resuscitated with an automated external defibrillator. Blood cultures grew methicillin-sensitive Staphylococcus aureus (MSSA). Echocardiography showed no evidence of infective endocarditis (IE); a pseudoaneurysm of the shunt vessel was identified as the likely source of infection. Chest computed tomography revealed a septic pulmonary embolus. Three weeks later, the patient developed metamorphopsia in the right eye. Visual acuity at presentation was 20/25 (right) and 20/20 (left). Ophthalmological evaluation, including optical coherence tomography (OCT) and OCT angiography, confirmed bilateral type 2 MNV. She received intravitreal aflibercept injections in both eyes, which reduced MNV activity and improved symptoms. No recurrence occurred over one year of follow-up. CONCLUSION: Bilateral MNV can develop in patients with sepsis due to shunt infection without evidence of IE. This case underscores the need to consider MNV as a potential complication not only in IE-related sepsis but also in sepsis from other sources, such as shunt infections.